My kid self-harms, now what?

6Jun2017

My top ten tips. . .

June 2017 marks the two year anniversary since I started this website and blog. Wow. I can’t believe how fast the time has gone by. My daughter, who has graciously allowed me to write about our journey in specific and heart-rending detail, will graduate from high school on Friday. Her hard work and dedication to recovery has paid off, and she continues to be the most inspirational person I know. To say that I’m proud of her and honored to be her mom is a huge understatement.

Over the years since I started sharing stories about my girl’s depression and self-harm, I have been contacted off-line by many people requesting support, helpful hints, and information to help their child deal with a mental health crisis. It has been my great privilege to break the silence that so often surrounds the diagnosis of mental illness and to raise awareness around treatment, education, and advocacy.

There’s much work left to do to end the stigma associated with mental illness and the misinformation and misunderstanding which perpetuate it still today. But the snowball has started rolling down the hill, and I’m convinced that our understanding of mental illness as a medical condition will soon generate the same caring and compassionate response from the community at large as any other diagnosable illness.

That said, the discovery that your child—a person you have raised and nurtured and loved—engages in the behavior of self-harm is heart-breaking and shocking. Of the many symptoms that accompanied my daughter’s depression, self-harm was among the hardest to accept and understand. There were, it sometimes seemed, as many opinions about why she engaged in self-harm as there were people involved in her treatment. Some people viewed it as a cry for attention, some as an addiction, and yet others as a means to reject her dad's and mom's values and express her individuality. All of these points likely had and have validity and discussing them is important, at the right time and place.

What’s important is for you to find the way to understand that makes the most sense to you, and then use that knowledge to help your child. Once I understood the mechanism of her relief from agonizing pain and despair, it was easier for me to find my compassion (see below). In that way, I could change my behavior and work hard to keep my expectations (of her and of me) in line. And I could focus my concentration on whatever mattered most in the moment.

I hope this list of ten tips helps you in a time of need if you discover your child is self-harming:

1. Take care of yourself. How could I possibly put self-care first on this list, you wonder? Because it the last thing you will feel like doing and will probably be the last thing you actually do. The needs of a child struggling with a mental health challenge can wear you down. Fast. Find 10 minutes a day to feed your soul. Grab a good book. If you can’t concentrate long enough to read, take a bath or go for a walk or sit and pray or create colorful art. You may be in for a long haul and your best chance at staying stalwart is to make yourself part of the agenda. Besides, you’ll also be a good role model.

2. Find an experienced therapist. (For them and for you) This is easier said than done, but if your child is self-harming, you need to work with clinicians who are knowledgeable about these behaviors. You need support, too. Even if you happen to be a clinician, when it is your own child who is hurting, you’re too close to the situation. You need a clear head to help guide you. Involve your child in the decision-making process as often as possible.

3. Get educated. Your therapist can help you with this, but it’s important to learn about this negative coping mechanism. As painful as it is to see your child hurt themselves (or to see the outcome of this behavior), remember that self-harm is not usually a suicidal act. This does not mean that the harming cannot escalate to suicide or that suicide won’t happen by accident. Self-harm is a complex symptom. The more you know and understand, the more compassion you will have to help you cope with the situation. (Compassion is mostly a verb by the way, a desire to reduce suffering. And, I would add—the actions to reduce suffering.) Two good books to start with are Cutting, by Steven Levenkron and Bodily Harm, by Karen Conterio and Wendy Lader. Consider contacting your local NAMI affiliate and taking the Basics or Family to Family class.

4. Reach out. I understand the temptation to withdraw, to pull back from your life, to distance yourself from family and friends. You may, in fact, need to distance yourself from certain people who can’t and won’t understand what you’re going through, but I learned that we heal in community. Find a place where you feel safe to share your story.

5. Identify your superpower. Which is NOT control. You have zero control over the situation except for yourself. Continue to seek appropriate support and services, but neither constant vigil nor authoritative demands will prevent a determined person from engaging in harmful behaviors. Maybe your superpower is compassion. Maybe it’s the ability to remain calm. Maybe it’s the ability to pick your battles. Whatever it is, cultivate it and remember that trying to control the actions of another person usually does more harm than good.

6. Trust your gut. No one knows your kid better than you do. If you think something is wrong, it probably is. Also, even the most helpful help can be off-base. If you get a sense that the help isn’t helping, pay attention! And if you feel like you made a mistake, forgive yourself.

7. Don’t buy in to stigma and shame. Mental illness, depression, self-harm. These are not “pull yourself up by your bootstrap” issues. Don’t tell someone to “get over it” or say “you’ll be fine.” And don’t bury your head in the sand. You may feel a full range of emotions including guilt, despair, anger, disgust, grief, embarrassment and fear. Shame may try to convince you that you are a bad person because your child is struggling. No! You are doing the best you can, and as we say at NAMI, “You can’t know what no one told you.” Don’t let stigma and shame silence you or prevent you from seeking the help you need.

8. Consider medication. If your child’s condition is debilitating, you might want to consider medication. The decision to put a child on medication is difficult. It was for me, but I know that my daughter would not be in recovery if we hadn’t helped ease her condition with medications in addition to therapy. Brain chemistry is malfunctioning with mental illness. Consult a specialist who works with children and psychotropic medications, not your regular pediatrician.

9. Exercise empathetic mindful presence. When your child is lost in the grip of depression and self-harm, they are not thinking clearly. Again, mental illness is a brain disorder which means that the brain is not functioning correctly. Trying to rationalize, instruct, and reason with someone at this time is ineffective. The most powerful tool you have at your disposal to help your child is YOU, if you can remain calm and judgment free. Being fully present in the face of what can be extreme behavior takes practice and patience. The “pay off” can be great in that your presence may act almost as a conduit, allowing for negative emotions to flow out of your child, thereby reducing their pain.

10. Remember: You are not alone. Twenty percent of adolescents between the ages of 13 and 18 (see NAMI fact page here) will be diagnosed with a mental illness. Statistical numbers equate to real people, real children, and a very large number of them. There are many of us who have had experiences with our child and a difficult diagnosis. We’re out here, ready and willing to help you as best we can.

Please, please, please remember that early intervention leads to better outcomes. (Read my post about early intervention here. And other helping posts here on IEPs and here on being aware.)

A few more resources:

Books:
-Shame/empathy/embracing imperfection/so much more: Brené Brown, anything and everything, but especially The Gifts of Imperfection and I Thought It Was Just Me.

-Being in the present moment: Eckhart Tolle, The Power of Now.

-Compassion: Pema Chödrön, anything and everything, especially The Pocket Pema Chödrön (you can take it with you everywhere you go.)

-Perspective of someone who self-harmed: Sharp, by David Fitzpatrick, and Skin Game, by Caroline Kettlewell.

-Education: A Bright Red Scream, by Marilee Strong

-Anger: Anger, by Thich Nhat Hanh

-History and personal story: No One Cares About Crazy People, by Ron Powers.

(Disclaimer: Although I have a Master's Degree in Counseling Psychology, I am not a clinician. I write as a mom who has lived through a mental health challenge with my daughter and survived to tell the tale. This advice is not intended to replace advice from licensed clinicians or doctors.)

Thank you so much, Wendy. It has been long and there are parts of our journey I'd trade in if I could, especially for my girl. But, at the end of the day, we are stronger for what we've been through and closer, too. It may be an odd way to put it, but I cherish what we went through that lead us to where we are. Thanks for reading and commenting.

Tracey, this is such wonderful advice and wisdom. Hard won, for sure. You've been at this for two years already? Think of all the people you've helped, including me. You are courageous, brilliant, and have an immense heart.

Oh my goodness, Maria. Thank you so much for taking the time to read and to leave this extraordinarily kind comment. You have been part of my journey since the very beginning. Thank you for being there and here. Having you in my life is a gift I don't take for granted. XOXO

Tracey, Thank you for continuing to be a wise, compassionate voice around mental illness. I appreciate your willingness (and Olivia's!) to speak with such honesty--it has helped us personally, and inspired my writing.

I am sad that you and your daughter had the lived experience that made writing this possible. The reality is that many people deal with mental illness and yes, the sooner treatment begins, the better. I sure wish my parents were able to identify my issues and help me back when I was in college. You and your daughter are both stars in my book! You are both inspirations.

Thank you, again, Sue. Your support and friendship mean the world to me. I, too, am sad that we went through these experiences, but I also acknowledge that we wouldn't be who we are without them. I was asked once if I could change what happened, would I? My answer was, "Absolutely, if I could take away my daughter's pain. Otherwise, absolutely not." Thanks for reading and commenting.

Tracey, WONDERFUL blog post. #9 speaks so loudly to me. I have a co-worker going through hell right now as a caregiver for her husband who's bi-polar. She's trying to fix everything and only making herself crazy. I passed this along to her.

I appreciate your honesty. IT was here during the NAMI class you taught and it's here in your writing. You are inspirational!

Oh, Linda. Thank you for your kind comments and for taking the time to write this note. I'm sorry to read about your friend and her husband's struggle. It is so hard. And it is so painful to feel powerless in the face of what can be debilitating illness. I'm glad you passed this along. I hope it helps. Encourage your friend gently to take a class or join a support group if she hasn't already.

Thank you, Faithe. And yes. Denial is a tricky thing. It's so painful to accept when a child is hurting and struggling and may have a mental health condition. The more we talk about it, hopefully we can lessen the stigma. Thank you for reading and for your comment.